Psychological factor, metacognition, is associated with the advantage of suturing techniques acquired on a virtual reality simulator of robot‐assisted surgery

Abstract

Robot-assisted surgery is expected to help overcome the technical difficulty of laparoscopic surgery, and to spread widely as a minimally-invasive alternative to open or laparoscopic surgery. Although novel surgical techniques have been developed, how to gain the maturity for using such techniques has become a very important consideration. Investigators for educational psychology have studied many factors in their correlation with success from learning. Among these factors, we focused on "metacognition". Metacognition is defined as the ability to reflect on, understand and control one's learning.1 This has been distinguished from two major categories, the "knowledge of cognition" and the "regulation of cognition". Previous studies have reported that students with good metacognition showed good academic performance compared with those with poor metacognition.2, 3 Based on this, we herein report on the relationship between metacognition and the learning curve for the robot-assisted surgical technique using the Mimic dV-Trainer (MdVT; Mimic Technologies, Seattle, WA, USA).4 A total of 19 urological surgeons who neither had any previous experience with the MdVT nor were a main surgeon of robot-assisted surgery carried out two kinds of suturing task, "Suture Sponge" and "Thread the Rings", repeated twice. Their performances were recorded using a built-in scoring algorithm. Their metacognition was also assessed using well-validated questionnaires. The mastery of laparoscopic surgery was not associated with the scores of metacognition among the participants of the present study (Table S1). Also, there was no significant correlation between the initial scores of suturing tasks and those in metacognition. In contrast, there were significant correlations between the scores of both suturing tasks and the overall metacognition score in the second trial (Fig. 1a,b). Scattergram showing the correlation between overall scores of metacognition and those of suturing tasks: (a) Suture Sponge and (b) Thread the Rings. Scattergram showing the correlation between the scores of two major metacognition categories, (c,d) knowledge of cognition and (e,f) regulation of cognition, and those of suturing tasks. In every panel, the x-axis indicates the overall scores of metacognition or scores in the metacognition categories, and the y-axis indicates the scores from the suturing tasks. R, correlation coefficient. Metacognition consists of two major categories, the knowledge of cognition and the regulation of cognition.1 Thus, we next examined the correlation between the scores for the suturing tasks and those of these categories. In both tasks, and in both categories, there were significant correlations between the scores of the suturing tasks and those of the metacognition in the second trial, which were not shown in the first trial (Fig. 1c–f). We showed the involvement of metacognition in surgeons for gaining the fundamental techniques necessary for carrying out robot-assisted surgery by using MdVT. Robot-assisted surgery will become more and more widely used in the near future, and at the same time, a more efficient style of education for gaining the necessary surgical skills will be required. In real surgery, there are many important factors besides the technique used, such as the anatomical understanding and the cooperation of the assistant staff. Although we herein focused only on gaining the techniques, the evidence from the present study might provide some benefit for training urological surgeons the necessary skills for carrying out robot-assisted surgery. We believe that further investigation of the role of metacognition in learning the skills necessary for carrying out robot-assisted surgery might allow for the evaluation of the potential characteristics required for surgical residents, and to improve their learning curve for these skills. None declared. Table S1 The scores of metacognition I in certified laparoscopic surgeons and non-certified